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FORM 1045 REV. 1-7-30 NATIONAL OFFICERS CENTRAL COMMITTEE HERBERT HOOVER. PRESIDENT JOHN BARTON PAYNE, CHAIRMAN MRS. AUGUST BELMONT ROBERT W. DE FOREST. VICE PRESIDENT CORNELIUS N. BLISS CALVIN COOLIDGE, VICE PRESIDENT THE AMERICAN RED CROSS MABEL T. BOARDMAN THOMAS D. THACHER, COUNSELOR JOSEPH P. COTTON OGDEN L. MILLS, TREASURER NATIONAL HEADQUARTERS MRS. HENRY P. DAVISON E. B. DOUGLAS MABEL T. BOARDMAN, SECRETARY WASHINGTON, D.C. MRS. FRANK V. HAMMAR MAJ. GEN. M. W. IRELAND SAMUEL KNIGHT NATIONAL EXECUTIVE OFFICERS OGDEN L. MILLS JOHN BARTON PAYNE, CHAIRMAN GUSTAVUS D. POPE MRS. HENRY R. REA JAMES L. FIESER, VICE CHAIRMAN REAR ADMIRAL CHARLES E. RIGGS ERNEST P. BICKNELL, VICE CHAIRMAN JOHN D. RYAN JAMES K. McCLINTOCK. VICE CHAIRMAN GEORGE E. SCOTT THOMAS D. THACHER ELIOT WADSWORTH Mar, 14-31 Dear Madam: The National Committee on Red Cross Nursing Service requires us to submit, annually, a list of all the Red Cross Nurses enrolled with our Committee, with their latest addresses. We are extremely anxious to make a very complete report to National Headquarters and ask for your cooperation. Please answer the following questions and return this form to me, in enclosed envelope, at the earliest possible date. IMPORTANT: Yours sincerely, In order to render prompt service Chairman or in time of disaster, enrolled Red Cross MISS FLORENCE BLACK Secretary. nurses should report at once to the 922 FLOYD AVENUE Secretary of the Local Committee under RICHMOND, VA. Local Committee. which they are enrolled. Do not forget the address of the Secretary. Name in full namine Jacquelin minor If married, give husband's name - Permanent address 922 Floyd are Richmond Virginia (STREET, ETC.) (CITY) (COUNTY) (STATE) Probable address for the next year Same (STREET, ETC.) Telephone No. 5-6600 (CITY) (COUNTY) (STATE) Name and address of nearest relative or friend, in United States, through whom you may be communicated with in an emergency. (State relationship) John B. minor 1702 Park here. Richwood Beather Underline the type of work you are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public Health - Institutional - Private Duty - Industrial - Office Nurse - Registrar. Are you an instructor of Red Cross classes in Home Hygiene and Care of the Sick? no Have you ever been? no Indicate present physical condition fair Would you respond to an emergency call in event of epidemic, disaster, war, etc. if possible Badge No. 1338 Current date march 3- 1931 NOTE. -If the nurse does not complete and return this questionnaire, and can not be located within two years, her enrolment will be annulled.

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    "ocrText": "FORM 1045 REV. 1-7-30\nNATIONAL OFFICERS\nCENTRAL COMMITTEE\nHERBERT HOOVER. PRESIDENT\nJOHN BARTON PAYNE, CHAIRMAN\nMRS. AUGUST BELMONT\nROBERT W. DE FOREST. VICE PRESIDENT\nCORNELIUS N. BLISS\nCALVIN COOLIDGE, VICE PRESIDENT\nTHE AMERICAN RED CROSS\nMABEL T. BOARDMAN\nTHOMAS D. THACHER, COUNSELOR\nJOSEPH P. COTTON\nOGDEN L. MILLS, TREASURER\nNATIONAL HEADQUARTERS\nMRS. HENRY P. DAVISON\nE. B. DOUGLAS\nMABEL T. BOARDMAN, SECRETARY\nWASHINGTON, D.C.\nMRS. FRANK V. HAMMAR\nMAJ. GEN. M. W. IRELAND\nSAMUEL KNIGHT\nNATIONAL EXECUTIVE OFFICERS\nOGDEN L. MILLS\nJOHN BARTON PAYNE, CHAIRMAN\nGUSTAVUS D. POPE\nMRS. HENRY R. REA\nJAMES L. FIESER, VICE CHAIRMAN\nREAR ADMIRAL CHARLES E. RIGGS\nERNEST P. BICKNELL, VICE CHAIRMAN\nJOHN D. RYAN\nJAMES K. McCLINTOCK. VICE CHAIRMAN\nGEORGE E. SCOTT\nTHOMAS D. THACHER\nELIOT WADSWORTH\nMar, 14-31\nDear Madam:\nThe National Committee on Red Cross Nursing Service requires us to submit,\nannually, a list of all the Red Cross Nurses enrolled with our Committee, with their\nlatest addresses. We are extremely anxious to make a very complete report to National\nHeadquarters and ask for your cooperation. Please answer the following questions and\nreturn this form to me, in enclosed envelope, at the earliest possible date.\nIMPORTANT:\nYours sincerely,\nIn order to render prompt service\nChairman or\nin time of disaster, enrolled Red Cross\nMISS FLORENCE BLACK\nSecretary.\nnurses should report at once to the\n922 FLOYD AVENUE\nSecretary of the Local Committee under\nRICHMOND, VA.\nLocal Committee.\nwhich they are enrolled. Do not forget\nthe address of the Secretary.\nName in full namine Jacquelin minor\nIf married, give husband's name -\nPermanent address 922 Floyd are\nRichmond\nVirginia\n(STREET, ETC.)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address for the next year\nSame\n(STREET, ETC.)\nTelephone No. 5-6600\n(CITY)\n(COUNTY)\n(STATE)\nName and address of nearest relative or friend, in United States, through whom you may\nbe communicated with in an emergency. (State relationship)\nJohn B. minor 1702 Park here. Richwood\nBeather\nUnderline the type of work\nyou are now doing: - Army - Navy - U.S.P.H. Hospital - U.S.Vet. Hospital - Public\nHealth - Institutional - Private Duty - Industrial - Office Nurse - Registrar.\nAre you an instructor of Red Cross classes in Home Hygiene and Care of the Sick?\nno\nHave you ever been? no\nIndicate present physical condition fair\nWould you respond to an emergency call in event of epidemic, disaster, war, etc. if possible\nBadge No. 1338\nCurrent date march 3- 1931\nNOTE. -If the nurse does not complete and return this questionnaire, and can not be\nlocated within two years, her enrolment will be annulled."
}